Federal Register / Vol. 71, No.
208 / Friday, October 27, 2006 / Proposed Rules 62957
Protection of Children
We have analyzed this proposed rule
under Executive Order 13045,
Protection of Children from
Environmental Health Risks and Safety
Risks. This rule is not an economically
significant rule and would not create an
environmental risk to health or risk to
safety that might disproportionately
affect children.
Indian Tribal Governments
This proposed rule does not have
tribal implications under Executive
Order 13175, Consultation and
Coordination with Indian Tribal
Governments, because it would not have
a substantial direct effect on one or
more Indian tribes, on the relationship
between the Federal Government and
Indian tribes, or on the distribution of
power and responsibilities between the
Federal Government and Indian tribes.
Energy Effects
We have analyzed this proposed rule
under Executive Order 13211, Actions
Concerning Regulations That
Significantly Affect Energy Supply,
Distribution, or Use. We have
determined that it is not a ‘‘significant
energy action’’ under that order because
it is not a ‘‘significant regulatory action’’
under Executive Order 12866 and is not
likely to have a significant adverse effect
on the supply, distribution, or use of
energy. The Administrator of the
Information and Regulatory Affairs has
not designated it as a significant energy
action. Therefore, it does not require a
Statement of Energy Effects under
Executive Order 13211.
Technical Standards
The National Technology Transfer
and Advancement Act (NTTAA) (15
U.S.C. 272 note) directs agencies to use
voluntary consensus standards in their
regulatory activities unless the agency
provides Congress, through the Office of
Management and Budget, with an
explanation of why using these
standards would be inconsistent with
applicable law or otherwise impractical.
Voluntary consensus standards are
technical standards (e.g., specifications
of materials, performance, design, or
operation; test methods; sampling
procedures; and related management
systems practices) that are developed or
rmajette on PROD1PC67 with PROPOSALS1
adopted by voluntary consensus
standards bodies.
This proposed rule does not use
technical standards. Therefore, we did
not consider the use of voluntary
consensus standards.
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Environment
We have analyzed this proposed rule
under Commandant Instruction
M16475.lD and Department of
Homeland Security Management
Directive 5100.1, which guide the Coast
Guard in complying with the National
Environmental Policy Act of 1969
(NEPA) (42 U.S.C. 4321–4370f), and
have concluded that there are no factors
in this case that would limit the use of
a categorical exclusion under section
2.B.2 of the Instruction. Therefore, we
believe this proposed rule should be
categorically excluded, under figure 2–
1, paragraph (32)(e) of the Instruction,
from further environmental
documentation. Under figure 2–1,
paragraph 32(e) of the Instruction, an
‘‘Environmental Analysis Checklist’’
and a ‘‘Categorical Exclusion
Determination’’ are not required for this
rule. However, comments on this
section will be considered before the
final rule.
List of Subjects in 33 CFR Part 117
Bridges.
Regulations
For the reasons discussed in the
preamble, the Coast Guard proposes to
amend 33 CFR part 117 as follows:
PART 117—DRAWBRIDGE
OPERATION REGULATIONS
1. The authority citation for part 117
continues to read as follows:
Authority: 33 U.S.C. 499; 33 CFR 1.05–
1(g); Department of Homeland Security
Delegation No. 0170.1; section 117.255 also
issued under the authority of Pub. L. 102–
587, 106 Stat. 5039.
2. Revise § 177.899 to read as follows:
§ 117.899 Youngs Bay and Lewis and
Clark River.
(a) The draw of the US101 (New
Youngs Bay) highway bridge, mile 0.7
across Youngs Bay at Smith Point shall
open on signal for the passage of vessels
if notice is given at least one half-hour
in advance to the drawtender at the
Lewis and Clark River Bridge by marine
radio, telephone, or other suitable
means from 7 a.m. to 5 p.m. Monday
through Friday and from 8 a.m. to 4
p.m. on Saturday and Sunday. At all
other times, including all federal
holidays except Columbus Day, notice is
required by telephone at least two hours
in advance. The opening signal shall be
two prolonged blasts followed by one
short blast.
(b) The draw of the Oregon State (Old
Youngs Bay) highway bridge, mile 2.4,
across Youngs Bay at the foot of Fifth
Street, shall open on signal for the
PO 00000 Frm 00016 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
passage of vessels if notice is given at
least one half-hour in advance to the
drawtender at the Lewis and Clark River
Bridge by marine radio, telephone, or
other suitable means from 7 a.m. to 5
p.m. Monday through Friday and from
8 a.m. to 4 p.m. Saturday and Sunday.
At all other times, including all federal
holidays except Columbus Day, notice is
required by telephone at least two hours
in advance. The opening signal is two
prolonged blasts followed by one short
blast.
(c) The draw of the Oregon State
(Lewis and Clark River) highway bridge,
mile 1.0, across the Lewis and Clark
River, shall open on signal for the
passage of vessels if notice is given at
least one half-hour in advance by
marine radio, telephone, or other
suitable means from 7 a.m. to 5 p.m.
Monday through Friday and from 8 a.m.
to 4 p.m. on Saturday and Sunday. At
all other times, including all federal
holidays except Columbus Day, notice is
required by telephone at least two hours
in advance. The opening signal is one
prolonged blast followed by four short
blasts.
Dated: October 13, 2006.
R.R. Houck,
Rear Admiral, U.S. Coast Guard, District
Commander,Thirteenth Coast Guard District.
[FR Doc. E6–17971 Filed 10–26–06; 8:45 am]
BILLING CODE 4910–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Part 483
[CMS–3191–P]
RIN 0938–AN79
Medicare and Medicaid Programs; Fire
Safety Requirements for Long Term
Care Facilities, Automatic Sprinkler
Systems
AGENCY: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
SUMMARY: This proposed rule would
require all long term care facilities to be
equipped with sprinkler systems. This
proposed rule especially requests public
comments on the duration of a phase-in
period to allow long term care facilities
to install such systems.
DATES: To be assured consideration,
comments must be received at one of
the addresses provided below, no later
than 5 p.m. on December 26, 2006.
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 62958 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
ADDRESSES: In commenting, please refer
to file code CMS–3191–P. Because of
staff and resource limitations, we cannot
accept comments by facsimile (fax)
transmission.
You may submit comments in one of
four ways (no duplicates, please):
1. You may submit electronic
comments on specific issues in this
regulation to http://www.cms.hhs.gov/
eRulemaking. Click on the link ‘‘Submit
electronic comments on CMS
regulations with an open comment
period.’’ (Attachments should be in
Microsoft Word, WordPerfect, or Excel;
however, we prefer Microsoft Word.)
2. By regular mail. You may mail
written comments (one original and two
copies) to the following address ONLY:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS–3191–
P, P.O. Box 8012, Baltimore, MD 21244–
8012.
Please allow sufficient time for mailed
comments to be received before the
close of the comment period.
3. By express or overnight mail. You
may send written comments (one
original and two copies) to the following
address only:
Centers for Medicare & Medicaid
Services, Department of Health and
Human Services, Attention: CMS–3191–
P, Mail Stop C4–26–05, 7500 Security
Boulevard, Baltimore, MD 1244–1850.
4. By hand or courier. If you prefer,
you may deliver (by hand or courier)
your written comments (one original
and two copies) before the close of the
comment period to one of the following
addresses. If you intend to deliver your
comments to the Baltimore address,
please call telephone number (410) 786–
9994 in advance to schedule your
arrival with one of our staff members.
Room 445–G, Hubert H. Humphrey
Building, 200 Independence Avenue,
SW., Washington, DC 20201; or 7500
Security Boulevard, Baltimore, MD
21244–1850.
(Because access to the interior of the
HHH Building is not readily available to
persons without Federal Government
identification, commenters are
encouraged to leave their comments in
the CMS drop slots located in the main
lobby of the building. A stamp-in clock
is available for persons wishing to retain
a proof of filing by stamping in and
retaining an extra copy of the comments
being filed.)
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Comments mailed to the addresses
indicated as appropriate for hand or
courier delivery may be delayed and
received after the comment period.
Submission of comments on
paperwork requirements. You may
submit comments on this document’s
VerDate Aug<31>2005 13:23 Oct 26, 2006 Jkt 211001
paperwork requirements by mailing
your comments to the addresses
provided at the end of the ‘‘Collection
of Information Requirements’’ section in
this document.
For information on viewing public
comments, see the beginning of the
SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Danielle Shearer, (410) 786–6617; James
Merrill, (410) 786–6998; Jeannie Miller,
(410) 786–3164; or Rachael Weinstein,
(410) 786–6775.
SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome
comments from the public on all issues
set forth in this rule to assist us in fully
considering issues and developing
policies. You can assist us by
referencing the file code CMS–3191–P
and the specific ‘‘issue identifier’’ that
precedes the section on which you
choose to comment.
Inspection of Public Comments: All
comments received before the close of
the comment period are available for
viewing by the public, including any
personally identifiable or confidential
business information that is included in
a comment. We post all comments
received before the close of the
comment period on the following Web
site as soon as possible after they have
been received: http://www.cms.hhs.gov/
eRulemaking. Click on the link
‘‘Electronic Comments on CMS
Regulations’’ on that Web site to view
public comments.
Comments received timely will also
be available for public inspection as
they are received, generally beginning
approximately 3 weeks after publication
of a document, at the headquarters of
the Centers for Medicare & Medicaid
Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday
through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an
appointment to view public comments,
phone 1–800–743–3951.
I. Background
[If you choose to comment on issues
in this section, please indicate the
caption ‘‘Background’’ at the beginning
of your comment.]
The Life Safety Code (LSC), published
by the National Fire Protection
Association (NFPA), a private, nonprofit
organization dedicated to reducing loss
of life due to fire, is a compilation of fire
safety requirements. The LSC contains
fire safety requirements for both new
and existing buildings. It is updated
through a consensus process and
generally published every 3 years.
Sections 1819(d)(2) and 1919(d)(2) of
the Social Security Act (the Act) require
PO 00000 Frm 00017 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
that long term care facilities
participating in the Medicare and
Medicaid programs meet the provisions
of the edition of the LSC that is adopted
by the Secretary.
Beginning with the adoption of the
1967 edition of the LSC in 1971,
Medicare and Medicaid regulations
have historically incorporated the LSC
requirements by reference for all long
term care facilities as well as other
providers, while providing the
opportunity for a Secretarial waiver of a
requirement under certain
circumstances. The statutory basis for
incorporating NFPA’s LSC for our other
providers is under the Secretary’s
general rulemaking authority at sections
1102 and 1871 of the Act, and under
provider-specific provisions of title
XVIII that permit us to issue regulations
to protect the health and safety of
participants in Medicare and Medicaid.
We adopted the LSC to ensure that
patients and residents are consistently
protected from fire, regardless of the
location in which they receive care.
Since adopting and enforcing the 1967
and subsequent editions of the LSC,
there has been a significant decline in
the number of multiple death fires,
indicating that the LSC has been
effective in improving fire safety in
health care facilities.
On October 26, 2001, we published a
proposed rule (66 FR 54179), and on
January 10, 2003, we published a final
rule in the Federal Register, entitled
‘‘Fire Safety Requirements for Certain
Health Care Facilities’’ (68 FR 1374). In
that final rule, we adopted the 2000
edition of the LSC provisions as the
standard governing Medicare and
Medicaid health care facilities,
including long term care facilities. The
final rule required all existing long term
care facilities to comply with the 2000
edition of the LSC.
The 2000 edition of the LSC required
all newly constructed buildings
containing health care facilities to have
an automatic sprinkler system installed
throughout the building. However, like
all previous editions, the LSC did not
require existing buildings to install
automatic sprinkler systems throughout
if they met certain construction
standards, ranging from the size of the
buildings to the types of material used
in their construction.
In accordance with the 2000 edition
of the LSC, an existing building that
meets the above-mentioned construction
standards must install sprinklers if it
undergoes a major renovation. However,
in such cases, it is only required to
install sprinklers in the renovated
section(s). Therefore, a building may
only be sprinklered on one floor or one
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 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
wing. We did not receive any timely
public comments in response to the
October 2001 proposed rule that
addressed the issue of installing
automatic sprinkler systems in
buildings not undergoing major
renovations. That is to say, no public
comments supported, questioned or
challenged our proposal to incorporate
this LSC provision by reference.
[If you choose to comment on issues
in this section, please include the
caption ‘‘GAO Report’’ at the beginning
of your comments.]
A recent Government Accountability
Office (GAO) report entitled ‘‘Nursing
Home Fire Safety: Recent Fires
Highlight Weaknesses in Federal
Standards and Oversight’’ (GAO–04–
660, July 16, 2004, http://www.gao.gov/
new.items/d04660.pdf) examined two
long term care facility fires (Hartford
and Nashville) in 2003 that resulted in
31 total resident deaths. The report
examined Federal fire safety standards
and enforcement procedures, as well as
results from the fire investigations of
these two incidents. The report
recommended that fire safety standards
for unsprinklered facilities be
strengthened and cited sprinklers as the
single most effective fire protection
feature for long term care facilities.
In response to a recommendation
made in the GAO report, on March 25,
2005, we published an interim final rule
with comment period in the Federal
Register entitled, ‘‘Fire Safety
Requirements for Certain Health Care
Facilities; Amendment’’ (70 FR 15229).
This interim final rule added paragraph
(a)(7) to § 483.70, to require long term
care facilities, at minimum, to install
battery-operated smoke detectors in
resident sleeping rooms and public
areas, unless they have a hard-wired
smoke detector system in resident
rooms and public areas or a sprinkler
system installed throughout the facility.
Numerous public comments regarding
this regulation indicated that the proper
term for the fire safety device we
described is ‘‘smoke alarms’’ rather than
‘‘smoke detectors.’’ Therefore, we will
refer to these fire safety devices as
‘‘smoke alarms.’’ The final rule ‘‘Fire
Safety Requirements for Certain Health
Care Facilities; Amendment’’ also will
reflect this terminology change.
Paragraph (a)(7) would be rendered
moot by this proposed rule because all
facilities would be required to have
sprinklers throughout their buildings
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and would thus fall under one of the
two exceptions noted above. For this
reason, we are proposing to add a sunset
provision to paragraph (a)(7). The sunset
date for proposed paragraph (a)(7)(iv) in
§ 483.70 would correspond to the phase-
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in date of the sprinkler requirement. For
example, if all facilities were required to
have sprinklers installed throughout
their buildings by March 25, 2016, then
the sunset date of the smoke alarms
requirement in paragraph (a)(7)(iv)
would be March 25, 2016. We believe
this would reduce burden and
confusion for long term care providers.
[If you choose to comment on issues
in this section, please include the
caption ‘‘Current Fire Safety Status’’ at
the beginning of your comments.]
Structural fires in long term care
facilities are relatively common events.
From 1994 to 1999, an average of 2,300
long term care facilities reported a
structural fire each year (2004 GAO
Report). Although there were
approximately 2,300 fires in long term
care facilities per year, those fires only
resulted in an average of 5 fatalities
nationwide per year (2004 GAO Report).
The likelihood of a fatality occurring
due to a long term care facility fire was
quite low.
The likelihood of a high number of
fatalities occurring due to a long term
care facility fire was even lower. From
1990 to 2002, there were no major long
term care facility fires that resulted in a
high number of fatalities. The long term
care facility fires that did occur during
this time period either did not result in
fatalities or resulted in one or two
fatalities. For 12 years, there simply
were no major fires in long term care
facilities that could begin to compare to
the loss of life caused by the Hartford
and Nashville fires.
We believe that the low number of
fire-related fatalities each year is
attributable to the increasing use of
automatic sprinkler systems in long
term care facilities as a fire protection
method. State and local jurisdictions
often adopt new editions of the LSC
when they are published. Therefore, a
building constructed in 1991 likely met
the requirements of the 1991 edition of
the LSC. Beginning with the 1991
edition of the LSC, all newly built
facilities were required to have
automatic sprinkler systems. In
addition, beginning with the 1991
edition of the LSC, all facilities
undergoing major renovations were also
required by the LSC to install automatic
sprinkler systems at least in those
renovated areas. Therefore, as new
facilities have replaced old facilities,
and as facilities have been renovated,
the number of residents protected by
automatic sprinkler systems has
increased. The increase in the number
of automatic sprinkler systems and the
number of residents residing in
sprinklered buildings significantly has
PO 00000 Frm 00018 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
62959
decreased the likelihood of a fatality
occurring due to fire.
According to NFPA data cited in the
2004 GAO report, there is an 82 percent
reduction in the chance of death
occurring in a sprinklered building
when compared to the chance of death
occurring in an unsprinklered building.
In addition, we note that there has never
been a multiple death fire in a long term
care facility that had an automatic
sprinkler system installed throughout
the facility.
Automatic sprinkler systems are
effective in reducing the risk of fatalities
due to fire because they limit the size of
a developing fire and prevent the fire
from growing and spreading beyond the
area where the fire ignited. Limiting the
size of a fire and preventing it from
growing and spreading results in a
smaller number of individuals who are
threatened by the fire. In addition,
impeding the fire’s growth gives the
facility staff and residents and the local
fire department more time to respond to
the situation.
Automatic fire suppression through
sprinklers also alleviates some of the
current heavy reliance on facility staff to
implement the facility’s emergency
plan. Fires often occur at night, as both
the Hartford and Tennessee fires did,
when staffing levels are lowest.
Investigators of the Hartford fire
determined that the facility’s staff did
not fully implement the facility’s
emergency plan, and that may have
contributed to the number of fatalities in
that fire. The 2004 GAO report
concluded that, ‘‘reliance on staff
response as a key component of fire
protection may not always be realistic,
particularly in an unsprinklered
facility.’’ Limiting the area of a building
affected by a fire may result in less of
a need to evacuate or relocate residents,
thus eliminating some of the heavy
reliance on facility staff response.
The effectiveness of automatic
sprinkler systems has prompted some
States, including Virginia, Connecticut,
and Tennessee, to require that all long
term care facilities have sprinklers. The
NFPA also requires all long term care
facilities to have automatic sprinkler
systems as part of the 2006 edition of
the LSC. The American Health Care
Association (AHCA), one of the largest
long term care facility provider
organizations, supports installing
sprinkler systems in all long term care
facilities, and worked with the NFPA on
the provisions of the 2006 LSC.
[If you choose to comment on issues
in this section, please include the
caption ‘‘CMS Action’’ at the beginning
of your comments.]
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 62960 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
We support the NFPA in its decision
to include an automatic sprinkler
system requirement for all long term
care facilities in the 2006 edition of the
LSC. We have decided to proceed with
this rule, without adopting the NFPA
2006 edition of the LSC, because we
want to avoid further delay in requiring
an automatic sprinkler system in long
term care facilities. As the 2003 fires
demonstrated, there is a significant need
to improve fire safety in long term care
facilities in a timely manner. To adopt
the 2006 edition of the LSC, we are
required to go through notice and
comment rulemaking. In addition to the
time that it takes to carefully analyze the
LSC in its entirety, the rulemaking
process itself is a time-consuming
process that, even in the best case
scenario, takes 18 months to complete.
Given the large scope of the LSC, it is
probable that it would take even longer
to complete the full rulemaking process.
Therefore, it is probable that we would
not be able to adopt and enforce
compliance with the 2006 edition of the
LSC until 2008 or 2009. In addition, the
2008 or 2009 publication date of a final
rule would simply begin a probable
phase-in period, which could be
anywhere from 3 to 10 additional years.
We believe that delaying the rulemaking
process would be a disservice to all long
term care facility residents who reside
in buildings that do not have sprinklers.
Therefore, we have decided at this time
to proceed with rulemaking that does
not include adoption of the NFPA 2006
LSC.
We will continue to work with the
NFPA to revise and refine each edition
of the LSC. We are currently examining
the 2006 edition of the LSC in its
entirety and exploring the possibility of
adopting it for all Medicare and
Medicaid participating health care
facilities. We are soliciting public
comment about our decision to proceed
with rulemaking separate from the 2006
LSC. In addition, we may make changes
to this sprinkler rule according to public
comments that we receive that are
related to the sprinkler requirements in
the NFPA 2006 edition of the LSC.
We are also soliciting public comment
regarding our decision to regulate the
installation of automatic sprinkler
systems through Federal rulemaking
rather than deferring to State and local
jurisdictions. There has been discussion
within the larger long term care
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community about the advantages and
disadvantages of Federal, State and local
regulation in this area. In particular, we
would like public comments regarding
the necessity, advantages, and
disadvantages of this Federal regulation
requiring sprinklers. We would also like
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public comments regarding the
necessity, advantages, and
disadvantages of deferring to State and
local jurisdictions.
II. Provisions of the Proposed
Regulations
For the reasons described in section I
of this preamble, we are proposing a
rule with three main components. First,
the regulation proposes to add a sunset
provision to paragraph (a)(7) in § 484.70
that would correspond to the phase-in
date of the sprinkler requirement. This
sunset provision would provide that, as
of the phase-in date, we would no
longer enforce the requirement that
facilities have and maintain at least
battery-operated smoke alarms. Second,
this regulation proposes to require every
long term care facility to install an
approved, supervised automatic
sprinkler system in accordance with the
1999 edition of NFPA 13, Standard for
the Installation of Sprinkler Systems,
throughout the facility if it does not
have such a system already. Third, the
regulation proposes to require every
long term care facility to test, inspect,
and maintain an approved, supervised
automatic sprinkler system in
accordance with the 1998 edition of
NFPA 25, Standard for the Inspection,
Testing and Maintenance of Water-
Based Fire Protection Systems.
The proposed requirements of this
regulation include three technical terms:
‘‘approved,’’ ‘‘automatic,’’ and
‘‘supervised.’’ These terms are terms of
art in the fire safety community and are
included in NFPA 101, Life Safety Code,
with which long term care facilities
must already comply. There may be,
however, individuals who are not
familiar with the terms. Their
definitions are as follows:
• Approved means acceptable to the
authority having jurisdiction.
• Automatic means that which
provides a function without the
necessity of human intervention.
• Supervised means that the system
and particular components of the
system are monitored by a device with
auditory and visual signals that are
capable of alerting facility staff should
the system or one of its components
become inoperable for any reason.
The following section describes each
of the main components.
A. Sunset Provision
[If you choose to comment on issues
in this section, please include the
caption ‘‘Sunset Provision’’ at the
beginning of your comments.]
We are proposing in § 483.70(a)(7)(iv)
to add a sunset provision for smoke
alarms that would correspond to the
PO 00000 Frm 00019 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
phase-in date of the sprinkler
installation requirement. We are
proposing to add this provision because
otherwise paragraph (a)(7) would be
rendered moot by this proposed rule.
Paragraph (a)(7) requires long term care
facilities to have at least battery-
operated smoke alarms in resident
rooms and common areas. Facilities that
are fully sprinklered in accordance with
NFPA 13 are exempt from the smoke
alarm requirement. Once all facilities
install sprinkler systems in accordance
with the 1999 edition of NFPA 13, as we
are proposing to require, all facilities
would be exempt from the requirements
of paragraph (a)(7). We believe that it is
proper to state, in regulation, that the
smoke alarm requirement would cease
to be effective upon the phase-in date of
the sprinkler requirement. Therefore, we
propose to add a sunset provision to the
smoke alarm requirement.
B. Installation
[If you choose to comment on issues
in this section, please include the
caption ‘‘Installation’’ at the beginning
of your comments.]
We are proposing in § 483.70(a)(8)(i)
to require long term care facilities to
install approved, supervised automatic
sprinkler systems throughout their
facilities in accordance with NFPA 13,
Standard for the Installation of
Sprinkler Systems (which we would
incorporate by reference). If a long term
care facility was part of another
building, such as a hospital, then the
building would be required only to have
sprinklers in the long term care facility
section. The NFPA 13 specifies how to
properly design and install sprinkler
systems using the proper components.
The standards of NFPA 13 cover a wide
variety of factors that are involved in
designing and installing sprinkler
systems. The NFPA 13 is divided into
10 main chapters governing the design
and installation phases of automatic
sprinkler systems. They are as follows:
• General Information.
• Classification of Occupancies and
Commodities.
• System Components and Hardware.
• System Requirements.
• Installation Requirements.
• Hanging, Bracing, and Restraint of
System Piping.
• Design Approaches.
• Plans and Calculations.
• Water Supplies.
• System Acceptance.
The NFPA 13 is a very detailed
document, with a wide variety of
standards and exceptions to those
standards. The document provides
many options for the design and
installation of sprinkler systems so that
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 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
each system may be tailored to the
building in which it is installed. It is not
practical to discuss each and every
standard of NFPA 13 in this proposed
rule. The technical standards of NFPA
13, along with helpful background and
explanatory text, are in the Automatic
Sprinkler System Handbook, published
by the National Fire Protection
Association (8th edition. Puchovsky,
Milosh T., Ed.; 1999, Quincy, MA). The
Automatic Sprinkler System Handbook
contains more than 1,000 pages of
information and provides far more
information than this proposed rule.
Therefore, the following section will
only briefly discuss the general content
of each design and installation-related
chapter of NFPA 13, to provide an
overview of the factors that facilities
would be required to address when
designing and installing an automatic
sprinkler system.
Chapter 1, General Information,
discusses four separate areas. First, it
describes the scope of NFPA 13.
According to the Automatic Sprinkler
System Handbook, NFPA 13 provides
the minimum requirements for sprinkler
systems to operate during a fire. These
requirements focus on the design and
installation of sprinkler systems that use
automatic or open sprinklers that
discharge water to suppress or control a
fire.
Second, chapter 1 describes the
purpose of NFPA 13. The NFPA 13
focuses on the technical aspects of the
design and installation of sprinkler
systems in order to standardize these
areas ‘‘based on sound engineering
principles, test data, and field
experience.’’ The purpose of NFPA 13 is
to ensure through standardization that
sprinkler systems, when designed and
installed in buildings, are designed,
assembled, and installed in a safe and
effective manner using the correct
materials (for instance, pipes) and
information (for instance, system
diagrams).
Third, chapter 1 defines important
terms that are used throughout the
document. Frequently, the terms used in
NFPA 13 are specific to sprinkler
systems, and their definitions may not
be available in other resources. To avoid
any possible confusion, NFPA 13
provides an inclusive list of terms and
their definitions as they apply to
sprinkler systems. This list is one way
in which NFPA 13 standardizes
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sprinkler system requirements.
Finally, chapter 1 addresses the level
of protection that sprinkler systems are
expected to provide. Chapter 1–6.1
states that, ‘‘[a] building, where
protected by an automatic sprinkler
system installation, shall be provided
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with sprinklers in all areas.’’ The
success of a sprinkler system depends,
in large part, on how large a fire is when
it first begins and the initial sprinklers
are activated. If a fire begins in a
sprinklered area, then the sprinklers
would quickly be activated, spraying
water on the fire and surrounding areas.
These procedures would prevent the fire
from expanding and would therefore
protect the occupants of the building.
Conversely, if a fire begins in one part
of a building where there are no
sprinklers, then it would be allowed to
grow due to the lack of sprinklers. Once
the fire reached an area with sprinklers,
the fire would likely be too large for the
sprinklers to control. Sprinkler systems
are not intended to prevent a fire in an
unsprinklered area from spreading to a
sprinklered area. Therefore, NFPA 13
requires that sprinklers be installed
throughout a building. If there is a 2-
hour fire wall separating the section of
a building that contains a long term care
facility from the rest of the building,
then the long term care facility section
is considered to be its own building.
This means that we require only the
long term care facility section to have
sprinklers installed throughout. If there
is no 2-hour fire wall separating the long
term care facility from the rest of the
building, then the long term care facility
could choose to install a 2-hour fire wall
separation or sprinkler the entire
building.
Chapter 2, Classification of
Occupancies and Commodities, is
divided into two sections, one for
occupancies and the other for
commodities. Sprinkler systems are
designed using a variety of methods and
components within the requirements of
NFPA 13. The choice of design method
and components is based on how the
building is used. Chapter 2 identifies
the general occupancies and their fire
risk levels. It also identifies the many
different types of items that are stored
in buildings. These broad classifications
of occupancies and commodities enable
sprinkler system designers to tailor the
systems to the particular fire safety
needs of each building. The
classifications also help ensure that all
buildings, regardless of their
differences, are fully protected by
appropriate sprinkler systems.
Chapter 3, System Components and
Hardware, contains the general
requirements for the pieces that are used
to create a sprinkler system. First and
foremost, NFPA 13 requires that the
system components be listed. This
provision requires that the components
used to build a sprinkler system be on
a list published by an organization that
periodically inspects the products on
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62961
the list. The list states that the
component meets appropriate
designated standards or has been tested
and found suitable for a specific
purpose. Using listed components helps
ensure that the components, and thus
the system, are effective and reliable in
the event of a fire.
This chapter also covers the basic
requirements for sprinkler system
components. It requires that sprinklers
have certain specified discharge and
temperature characteristics. The chapter
also requires that facilities maintain a
sufficient number of replacement
sprinklers for each type of sprinkler
used in the facility. In addition to being
properly maintained, sprinklers may
need to be replaced. It is important that
a facility have enough sprinklers in its
possession in order to replace any
sprinklers immediately, so as not to
compromise the effectiveness and
reliability of the entire system in the
event of a fire.
Chapter 3 also contains requirements
for escutcheon plates, guards, shields,
aboveground pipes and tubes,
underground pipes, fittings, joinings,
hangers, valves, fire department
connections, waterflow alarms, and any
coatings that are on system components.
All of the requirements included in
chapter 3 of NFPA 13 exist to ensure
that the components used to construct
sprinkler systems will operate as needed
in the event of a fire. Some of the above
listed components, such as pipes, are
also addressed in other chapters of
NFPA 13.
Chapter 4, System Requirements, is
divided into requirements for the
different types of sprinkler systems that
may be used in a facility. The two main
categories of sprinkler systems are wet
and dry pipe systems. Wet pipe systems
are, in the most general terms, systems
in which the pipes contain water. When
the heat from a fire triggers the
sprinklers, the water is immediately
discharged. Dry pipe systems are filled
with air or nitrogen, rather than water.
When the air or nitrogen is released, the
water flows into the pipes and out
through the sprinklers. Within these two
broad sprinkler system categories, each
of which provides an equal level of fire
protection, NFPA 13 addressed many
variations that sprinkler system
designers may use to address the needs
of a particular building. The NFPA 13
leaves the choice of which system type
and variation to use for each building to
the sprinkler system designer. This
flexibility helps ensure that the
sprinkler system fully addresses the
unique needs of the building and its
occupants, thereby ensuring that the
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building is optimally protected by its
sprinkler system.
Chapter 5, Installation Requirements,
contains the requirements for the
normal arrangement of sprinkler system
components. The actual layout of a
specific sprinkler system may differ
from the normal layout described in this
chapter of NFPA 13 based on the
available water supply, type of
sprinkler, building construction
features, and other considerations.
However, the basic layout principles of
this chapter, such as the position and
location of sprinklers and valves, would
still apply. Chapter 5 helps ensure that
facilities are adequately protected by
providing the minimum and maximum
limits for sprinkler system components.
Within this minimum-maximum range,
system designers have the flexibility to
address the fire-safety needs of each
facility.
This chapter includes the specific
requirements for the many different
types of sprinklers. It covers sprinklers
ranging from standard pendent and
upright spray sprinklers to early
suppression fast-response sprinklers.
Each sprinkler type has advantages and
disadvantages depending on the
circumstances under which it is used.
The sprinkler type that may be
appropriate for one facility may not be
appropriate for another. Therefore,
NFPA 13 includes requirements for all
sprinkler types so that sprinkler system
designers have the flexibility to properly
utilize the right sprinkler type for the
job.
This chapter also includes
requirements for specialized facilities,
such as those that store flammable and
combustible materials. These
requirements would not pertain to long
term care facilities because health care
occupancies are considered to be light
hazards. As described in chapter 5, light
hazard buildings are not included in the
specialized facilities.
Chapter 6, Hanging, Bracing, and
Restraint of System Piping, contains the
requirements for the structural issues
that are related to installing sprinkler
piping systems. It identifies acceptable
types of hangers, how those hangers are
installed, how fire main joints are
restrained, and how pipes are protected
in areas where earthquakes occur. It is
important to ensure that sprinkler
system components are properly hung.
If they are improperly hung, then they
may randomly fall down and injure
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someone. In addition, improperly hung
components may fall under the pressure
of water flowing through them during a
fire situation, thus disabling the
sprinkler system and allowing the fire to
grow.
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Chapter 7, Design Approaches,
addresses the minimum amount of
water necessary to effectively control or
suppress a fire. This chapter requires
that water demands will be determined
using the occupancy hazard fire control
approach and permits special design
approaches to allow for the use of non-
standard components such as early
suppression fast-response sprinklers.
Facilities are required to ensure that
there is a sufficient amount of water to
control or suppress a fire.
Chapter 8, Plans and Calculations, is
an extension of chapter 7 that focuses
on the specific methodologies that can
be used to calculate and verify a
sprinkler system’s hydraulic demand
and its available water supply. Properly
calculating these values is a crucial step
in ensuring that the system has adequate
pressure and water to control or
suppress a fire. If a value is not properly
calculated and, for example, there is not
enough water available for a sprinkler
system to fully control a fire, then the
fire would be allowed to grow and
spread to other areas. The growth of the
fire would jeopardize the safety of the
building’s occupants.
This chapter also requires that
preliminary sprinkler system plans be
submitted for review to the authority
having jurisdiction for several reasons.
First, submitting the plans before
construction begins would help ensure
that the plans meet all requirements,
thus avoiding changes at a later date.
Also, submitting the plans for review
may help ensure that there are no errors.
A person who is not familiar with the
plan brings a fresh perspective and may
be able to more easily spot errors.
Finally, submitting plans early helps to
avoid misunderstandings. It is often
difficult to verbally describe how a
system would be constructed and how
it would function. A visual layout,
which is already required by most
authorities having jurisdiction, would
aid in communication and
understanding between all parties,
including the designer, the authority
having jurisdiction, and the
construction personnel.
Chapter 9, Water Supplies, further
expands on the areas that are related to
ensuring that a sprinkler system has
adequate water to control or suppress a
fire. It addresses situations where a
facility may not have an adequate
municipal water supply. Facilities may
need to install a pump to increase water
pressure and a tank to store extra water
to compensate for an inadequate
municipal supply. This chapter
includes the requirements that these
additional components would need to
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meet and addresses their proper use in
a sprinkler system.
Chapter 10, Systems Acceptance,
requires that sprinkler systems, once
constructed, be tested. System testing is
done in order to verify that the basic
requirements of all of the previous
chapters of NFPA 13 are satisfied, that
the construction of the system is
satisfactory, and that the system
performs as intended. During a system
test, facilities are required to examine
pipes, pipe joints, alarms, and other
components to ensure that they are
properly installed and that they are in
working order.
We would require that all long term
care facilities that do not already have
an automatic sprinkler system installed
throughout the building install such a
system in accordance with all of the
requirements NFPA 13, including but
not exclusive to those described above.
C. Phase-In
[If you choose to comment on issues
in this section, please include the
caption ‘‘Phase-in’’ at the beginning of
your comments.]
We are soliciting public comment
regarding an appropriate phase-in
timeframe for the installation of an
automatic sprinkler system. Such a
timeframe should provide for this
additional fire protection feature as
quickly as possible without undue
burden on long term care facilities.
We are soliciting public comment
regarding a phase-in period for this
requirement because we believe that it
would require a substantial amount of
time for a facility to plan and install an
automatic sprinkler system. A facility
would likely decide to use the services
of a fire safety consultant to design a
system that met its needs. Simply
securing these services could be a time-
consuming process. In addition, a
facility would probably need to
reallocate its resources and possibly
secure additional capital resources to
implement this requirement. This part
of the preparation would also take a
substantial amount of time to complete.
After preparing for the installation, a
facility would actually have to install
the system. Installation may require
removing ceilings, cutting walls, and
numerous other construction tasks.
Installation may also require
temporarily relocating residents, either
within the facility or to another facility,
while the sprinkler system was being
installed. We believe that most facilities
would choose to install sprinklers in
their existing facility, and would
therefore go through this preparation
and implementation process.
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 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
However, there may be some facilities
that choose to relocate to a building that
already has a sprinkler system installed
throughout the building. These facilities
may have planned to relocate to another
building for reasons unrelated to the
proposed sprinkler requirement. The
decision to move, however, may be
prompted by the proposed
requirements. For some facilities it may
be easier to move rather than to install
such a system in their current location.
Locating, purchasing or constructing,
and moving a facility would be a
lengthy process. A phase-in period, we
believe, would allow facilities that
choose to relocate to a sprinklered
building the chance to do so instead of
installing sprinklers in an existing
building.
Given these considerations, we
believe that requiring a long term care
facility to install an automatic sprinkler
system throughout its building requires
a phase-in period. We would encourage
facilities that were able to install an
automatic sprinkler system to do so as
soon as possible, rather than delay the
project until the effective date of a
phase-in period drew near.
D. Maintenance
[If you choose to comment on issues
in this section, please include the
caption ‘‘Maintenance’’ at the beginning
of your comments.]
We are proposing in § 483.70(a)(8)(ii)
to require that all long term care
facilities test, inspect, and maintain an
approved, supervised automatic
sprinkler system in accordance with the
1998 edition of NFPA 25, Standard for
the Inspection, Testing, and
Maintenance of Water-Based Fire
Protection Systems, which we propose
to incorporate by reference. Proper
inspections, tests, and maintenance of
sprinkler systems are critical to ensuring
that sprinkler systems function properly
on a continuous basis. Fires are, by
nature, unpredictable, and sprinkler
systems must be operable at all times to
ensure that buildings are protected
whenever and wherever fires occur.
National Fire Protection Association
25 covers a wide variety of testing,
inspection, and maintenance
requirements for the numerous types of
sprinkler systems that facilities may
install and the auxiliary equipment that
may be necessary for some facilities.
The general contents of the chapters of
NFPA 25 are as follows: Chapter 1,
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General Information, describes the
scope of the document; describes and
defines key ideas and terms; requires
that facilities maintain records of
inspections, tests, and maintenance
activities; establishes who is responsible
VerDate Aug<31>2005 13:23 Oct 26, 2006 Jkt 211001
for ensuring that all inspection, testing,
and maintenance duties are performed;
and requires that all inspection, testing,
and maintenance activities be
conducted in a safe manner.
• Chapters 2, Sprinkler Systems; 3,
Standpipe and Hose Systems; 7, Water
Spray Fixed Systems; and 8, Foam-
Water Sprinkler Systems, address the
specific inspection, testing, and
maintenance requirements for the
different types of sprinkler systems that
facilities may use, based upon their
needs and circumstances.
• Chapter 9, Valves, Valve
Components, and Trim, focuses on the
inspection, testing, and maintenance of
the valves, valve components, and trim
that are used to construct these systems.
• Chapters 4, Private Fire Service
Mains; 5, Fire Pumps, and 6, Water
Storage Tanks, address the inspection,
testing, and maintenance requirements
for auxiliary equipment that may be
necessary for a particular facility.
• Chapter 10, Obstruction
Investigation, provides the minimum
requirements for conducting
investigations of possible sources of
materials that can block pipes and
prevent them from operating properly.
• Chapter 11, Impairments, assures
that adequate measures are taken when
a sprinkler system is wholly or partially
shutdown, either on an emergency or
preplanned basis, to ensure that
increased fire safety risks are minimized
and that the shutdown is as short in
duration as possible.
• Chapter 12, Referenced
Publications, provides a list of other
NFPA publications that are referred to
within NFPA 25.
Facilities would be required by this
proposed rule to comply with all
applicable chapters of NFPA 25 once
they had installed their sprinkler
systems in accordance with the
requirements of NFPA 13.
III. Collection of Information
Requirements
Under the Paperwork Reduction Act
of 1995, we are required to provide 60-
day notice in the Federal Register and
solicit public comment before a
collection of information requirement is
submitted to the Office of Management
and Budget (OMB) for review and
approval. In order to fairly evaluate
whether an information collection
should be approved by OMB, section
3506(c)(2)(A) of the Paperwork
Reduction Act of 1995 requires that we
solicit comment on the following issues:
• The need for the information
collection and its usefulness in carrying
out the proper functions of our agency.
PO 00000 Frm 00022 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
62963
• The accuracy of our estimate of the
information collection burden.
• The quality, utility, and clarity of
the information to be collected.
• Recommendations to minimize the
information collection burden on the
affected public, including automated
collection techniques.
We are soliciting public comment on
each of these issues for the following
sections of this document that contain
information collection requirements:
In summary, § 483.70(a)(8)(ii) requires
that all long term care facilities test,
inspect, and maintain an approved,
supervised automatic sprinkler system
in accordance with the 1998 edition of
NFPA 25, Standard for the Inspection,
Testing, and Maintenance of Water-
Based Fire Protection Systems. This
section states that facilities would be
required by this proposed rule to
comply with all applicable chapters of
NFPA 25 once they have installed their
sprinkler systems in accordance with
the requirements of NFPA 13.
We believe that facilities would
utilize the services of a contractor for all
inspection, testing, and maintenance
activities, including documentation of
those activities. Therefore, no burden
would be associated with the
development of the documentation.
There would, however, be a burden
associated with the time and effort
required by facilities to maintain
documentation of inspections, tests, and
maintenance activities in accordance
with the standards outlined in the
NFPA 25. This burden would be the
time it takes to file the documentation.
The burden associated with these
requirements is estimated to be 1 hour
per long term care facility. Therefore,
we estimate it would take 2,462 total
annual hours (1 hour × 2,462 estimated
affected long term care facilities) to
satisfy this burden.
If you comment on these information
collection and recordkeeping
requirements, please mail copies
directly to the following:
Centers for Medicare & Medicaid
Services, Office of Strategic Operations
and Regulatory Affairs, Regulations
Development Group, Attn: Bill Parham,
CMS–3191–P, Room C4–26–05, 7500
Security Boulevard, Baltimore, MD
21244–1850; and Office of Information
and Regulatory Affairs, Office of
Management and Budget, Room 10235,
New Executive Office Building,
Washington, DC 20503, Attn: Carolyn
Lovett, CMS Desk Officer, CMS–3191–P,
Carolyn_Lovett@omb.eop.gov fax (202)
395–6974.
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 62964 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
IV. Regulatory Impact Statement
[If you choose to comment on issues
in this section, please indicate the
caption ‘‘Regulatory Impact Statement’’
at the beginning of your comment.]
A. Overall Impact
We have examined the impact of this
rule as required by Executive Order
12866 (September 1993, Regulatory
Planning and Review), the Regulatory
Flexibility Act (RFA) (September 19,
1980, Pub. L. 96–354), section 1102(b) of
the Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L.
104–4), and Executive Order 13132.
Executive Order 12866 (as amended
by Executive Order 13258, which
merely reassigns responsibility of
duties) directs agencies to assess all
costs and benefits of available regulatory
alternatives and, if regulation is
necessary, to select regulatory
approaches that maximize net benefits
(including potential economic,
environmental, public health and safety
effects, distributive impacts, and
equity). A regulatory impact analysis
(RIA) must be prepared for major rules
with economically significant effects
($100 million or more in any 1 year). We
have examined the impact of this
proposed rule, and we have determined
that this rule would not meet the criteria
to be considered economically
significant, and it would not meet the
criteria for a major rule.
This determination is based on a
variety of cost factors and phase-in
lengths. As a brief summary, we
estimate that this proposed rule would
cost $47.8 to $69.9 million, $73.5 to
$107.5 million, and $107.7 to $157.6
million annually, based on phase-in
periods of 10 years, 7 years, and 5 years,
respectively.
The estimated cost range for installing
a sprinkler system throughout an
existing building for an average size
unsprinklered facility (50,000 square
feet) would be $205,000 to $307,500,
depending on the cost per square foot.
The projected installation cost of this
proposed requirement would account
for approximately 0.4 to 0.6 percent of
an average facility’s actual revenue over
a 10-year period, 0.6 to 0.9 percent over
a 7-year period, and 0.8 to 1.2 percent
over a 5-year period.
The estimated cost range for installing
a sprinkler system throughout an
existing building for an average size
rmajette on PROD1PC67 with PROPOSALS1
partially sprinklered facility (37,500
square feet) would be $153,750 to
$230,625, depending on the cost per
square foot. The projected installation
cost of this proposed requirement would
account for approximately 0.3 to 0.5
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percent of an average facility’s actual
revenue over a 10-year period, 0.4 to 0.7
percent over a 7-year period, and 0.6 to
0.9 percent over a 5-year period.
The basis for these estimates is fully
described in section IV.B.2 of this
proposed rule. In that section, we
estimate that 1,947 partially sprinklered
facilities would, over a 10 year phase-
in period, install sprinklers throughout
their buildings in accordance with this
proposed rule, at a cost of $75,338 to
$416,250 per facility, based on size and
installation cost variables. The average
yearly installation cost for all partially
sprinklered facilities would be $37.2
million to $54.1 million. This
determination is further based on the
estimate that 515 unsprinklered
facilities would install sprinklers, at a
cost of $100,450 to $615,000 per facility.
The average yearly installation cost for
all unsprinklered facilities would be
$10.5 million to $15.8 million. The
average yearly installation cost
estimates are based on an example of a
10-year phase-in period.
The RFA requires agencies to analyze
options for regulatory relief of small
businesses. For purposes of the RFA,
small entities include small businesses,
nonprofit organizations, and small
government jurisdictions. Most
hospitals and most other providers and
suppliers are small entities, either by
nonprofit status or by having revenues
of $6 million to $29 million in any 1
year. For purposes of the RFA, most
entities affected by this proposed rule
are considered small businesses
according to the Small Business
Administration’s size standards, with
total revenues of $29 million or less in
any 1 year (for detail, see 65 FR 69432).
Individuals and States are not included
in the definition of a small entity.
According to our statistics, long term
care facilities, all of which would be
required to have sprinkler systems
throughout their buildings, earned a
total of $89.6 billion in 1999 (http://
www.cms.hhs.gov/statistics/nhe/
historical/t7.asp). According to the
National Nursing Home Survey: 1999
Summary (http://www.cdc.gov/nchs/
data/series/sr_13/sr13_152.pdf), there
were 18,000 nursing facilities in
operation at that time.
(Note: In the following paragraph the terms
‘‘average facility’’ and ‘‘small facility’’ are
strictly based on a revenue metric. That is,
the terms only describe the amount of
revenue that facilities would have.)
Long term care facilities vary in a
number of ways, ranging from the
number of residents to the predominant
source of payment for those residences.
For the purposes of our general analysis,
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we chose to assess the financial impact
of this proposed rule on an average
(median) facility and a much smaller
facility (50 percent below the median).
An average facility had approximately
$4,977,778 in revenue in 1999. A
facility with revenue 50 percent below
this average earned $2,488,889. For
example, over a 5-year, 7-year, and 10-
year period, an average facility would
earn $24,888,890, $34,844,446, and
$49,777,780, respectively. The small
facility would earn $12,444,445,
$17,422,223, and $24,888,890 over those
same time periods.
The projected cost of this proposed
requirement would account for 0.8 to
1.2 percent of a typical small facility’s
actual revenue over the 5-year example
period, 0.5 to 0.9 percent of such
facility’s actual revenue over the 7-year
example period, or 0.4 to 0.7 percent of
such facility’s actual revenue over the
10-year example period. We are
assuming that a small facility’s square
footage was 50 percent less than an
average facility’s square footage because
there is a strong correlation between the
size of a facility, as reflected by the
number of resident beds it has, and the
facility’s revenue level. We believe that,
given these estimates, this proposed rule
would not have a significant impact on
a substantial number of small entities.
In addition, section 1102(b) of the Act
requires us to prepare a regulatory
impact analysis if a rule may have a
significant impact on the operations of
a substantial number of small rural
hospitals. This analysis must conform to
the provisions of section 603 of the
RFA. For purposes of section 1102(b) of
the Act, we define a small rural hospital
as a hospital that is located outside of
a Metropolitan Statistical Area and has
fewer than 100 beds.
We know that 8.41 percent of long
term care facilities, 1,514 nationwide,
are located in hospitals, but we do not
know how many of those hospitals are
small rural hospitals. As described in
section IV.B.2 of this proposed rule,
75.89 percent of long term care facilities
nationwide report that they are fully
sprinklered. An additional 15.2 percent
report that they are partially
sprinklered, 4.14 percent report that
they are not sprinklered, and 4.77
percent did not report any information
about sprinklers. From this information,
we estimate that, of the 1,514 long term
care facilities located in hospitals, 1,204
are fully sprinklered, 241 are partially
sprinklered, and 69 are not sprinklered.
We assume that long term care facilities
that are located in small rural hospitals
are small as well.
For a small unsprinklered facility
with less than 50 resident beds, we
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 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
estimate that purchasing and installing
sprinklers would cost $100,450 (at $4.10
per square foot), $134,750 (at $5.50 per
square foot), or $150,675 (at $6.15 per
square foot). If the small unsprinklered
facility met the revenue criteria for a
smaller facility as described above, then
the projected cost of this proposed
requirement would account for 0.8 to
1.2 percent of the facility’s revenue over
the 5-year example period, 0.5 to 0.9
percent of the facility’s revenue over the
7-year example period, or 0.4 to 0.7
percent of the facility’s revenue over the
10-year example period.
For a small partially sprinklered
facility with less than 50 resident beds,
we estimate that purchasing and
installing sprinklers would cost $75,338
(at $4.10 per square foot), $101,063 (at
$5.50 per square foot), or $113,006 (at
$6.15 per square foot). If the small
partially sprinklered facility met the
revenue criteria for a smaller facility as
described above, then the projected cost
of this proposed requirement would
account for 0.7 to 0.9 percent of the
facility’s revenue over the 5-year
example period, 0.4 to 0.6 percent of the
facility’s revenue over the 7-year
example period, or 0.3 to 0.5 percent of
the facility’s revenue over the 10-year
example period.
Therefore, we believe that this
proposed rule would not have a
significant impact on the operations of
a substantial number of small rural
hospitals.
Section 202 of the Unfunded
Mandates Reform Act of 1995 also
requires that agencies assess anticipated
costs and benefits before issuing any
rule that may result in expenditure in
any 1 year by State, local, or tribal
governments, in the aggregate, or by the
private sector, of $110 million. This
proposed rule would not have an effect
on State, local, or tribal governments
because we do not propose to require
State, local, or tribal governments to
take any action. Based on our example
of a 10-year phase-in period, we
estimate that the private sector costs of
this proposed regulation would be $47.8
million to $69.9 million in any 1 year
for installation and an additional $1,019
per facility for maintenance. After the
initial installation period, we estimate
that the private sector costs of this
proposed regulation would $2,508,778
annually for maintenance. This estimate
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would not approach the $110 million
threshold; therefore, this section does
not assess the anticipated costs and
benefits as required by section 202 of
the Unfunded Mandates Reform Act of
1995.
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Executive Order 13132 establishes
certain requirements that an agency
must meet when it promulgates a
proposed rule (and subsequent final
rule) that imposes substantial direct
requirement costs on State and local
governments, preempts State law, or
otherwise has Federalism implications.
This proposed regulation would not
have any Federalism implications.
B. Anticipated Effects
1. Benefits
Decreasing Loss of Life
We believe that installing an
approved, supervised automatic
sprinkler system in accordance with
NFPA 13, Standard for the Installation
of Sprinkler Systems, throughout a long
term care facility would have a positive
impact on resident safety. According to
the July 2004 GAO report discussed
above, installing sprinklers decreases
the chances of fire-related deaths by 82
percent. In unsprinklered facilities,
there are 10.8 deaths per 1,000 fires. In
sprinklered facilities, there are 1.9
deaths per 1,000 fires.
The 2003 fires in Hartford and
Nashville resulted in more fire related
deaths (31) than there were for several
previous years combined. Both of these
fires occurred in unsprinklered
buildings. If sprinklers had been
installed in these facilities, and if they
were properly maintained, we estimate
that 82 percent of those fire-related
deaths may have been prevented, based
on an 82 percent reduction in the
chances of death occurring in a
sprinklered facility. We estimate that,
based on this reduction, 25 (82 percent
of 31 deaths = 25) lives could have been
saved by sprinklers in these two fires, or
13 lives in the Hartford fire and 12 lives
in the Nashville fire.
In 1997, the average age at admission
for long term care facility residents was
82.6 years, and 51 percent of long term
care facility residents were 85 years of
age or older (The Changing Profile of
Nursing Home Residents: 1985–1997.
Sahyoun NR, Pratt LA, Lentzner H, Dey
A, Robinson KN. Aging Trends; No. 4.
National Center for Health Statistics.
Hyattsville, MD; 2001). These numbers
reflect the overall demographic trend in
long term care facilities toward an older
patient population. For the purposes of
our analysis, we assume that the average
age of long term care facility residents
is 85. Also in 1997, the life expectancy
for an individual at age 85 was 6.3 years
(Older Americans 2000: Key Indicators
of Well-Being. Federal Interagency
Forum on Aging-Related Statistics.
http://www.agingstats.gov/
PO 00000 Frm 00024 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
62965
chartbook2000/tables-
healthstatus.html). This means that an
85-year-old long term care facility
resident could expect to live an average
of 6.3 more years.
Based on the assumption that the
average age of long term care facility
residents is 85 with a life expectancy at
age 85 of 6.3 years, we estimate that
sprinklers in these two fires would have
added 157.5 life years (25 lives saved ×
6.3 life years per life saved).
While the number of deaths in these
two fires is not typical of the number of
fire-related deaths in long term care
facilities as a whole, we believe that
they should still be taken into
consideration when discussing the
impact on the general long term care
facility resident population.
In a typical year from 1994 through
1999, about 2,300 long term care
facilities report structural fires (July
2004 GAO report). For the purposes of
our analysis, we estimate that 3,688 long
term care facilities currently do not have
sprinklers installed throughout the
buildings. (See section IV.B.2. of this
proposed rule).
We estimate that 25 percent (575) of
the 2,300 facilities that reported fires
did not have sprinklers installed
throughout their buildings. This
estimate is based on the results of the
2004 GAO report and a nationwide
survey of long term care facilities as
described in section IV.B.2 of this
proposed rule.
Based on the rate of 10.8 deaths per
1,000 unsprinklered facility fires, we
estimate that 6 deaths occurred in 575
fires in unsprinklered facilities
annually. (575 facilities = 57.5 percent
of 1,000 facilities; 57.5 percent of 10.8
deaths = 6 deaths). This estimate differs
slightly from the average number of
deaths (5) that occurred due to long
term care facility fires, as presented in
the July 2004 GAO report, because this
estimate predicts the number of deaths
that should statistically occur, based on
established percentages, rather than the
average number of deaths that occurred
annually in the past. This estimate is
prospective, whereas the 2004 GAO
figure is retrospective.
If these unsprinklered or partially
sprinklered facilities install sprinklers
throughout their buildings and those
sprinklers are properly maintained, then
we estimate that there would be 1 death
(57.5 percent × 1.9 deaths per 1,000
sprinklered facility fires = 1) in those
same 575 facilities. Installing sprinklers
in unsprinklered buildings would,
based on these estimates, save 5 lives
annually.
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 62966 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
Number of estimated annual fire-related
deaths in unsprinklered long term care
facilities
6 1
Given the estimate described above
that installing and maintaining sprinkler
systems in existing long term care
facilities would save 5 lives annually,
we estimate that sprinklers would save
31.5 life years annually (5 lives saved ×
6.3 years gained per life).
TABLE 2.—LIFE YEARS
Number of life years Number of life years
gained per life saved gained annually
6.3 31.5
There are a wide variety of estimates
regarding the statistical value of a
quality-adjusted life year. That is, there
are numerous studies that attempt to
quantify how much individuals and
society are willing to pay to gain a
single, quality year of life, known as a
quality-adjusted life year. These studies,
using one or more of four different
methodologies, have estimated that
individuals and society are willing to
pay between $50,000 and $450,000 for
a quality-adjusted life year. Due to the
fact that there is no widely accepted
standard value, we have refrained from
estimating the statistical value of each
life year that would be gained as a result
of a final rule requiring sprinklers in all
long term care facilities.
Decreasing Loss of Property
As a result of installing and properly
maintaining sprinklers, we anticipate
that facilities that experience fires
would lose less property. While the
amount of property damage and loss
that would be prevented by installing
and maintaining sprinklers is not
readily quantifiable, we believe that the
amount of damage prevented would be
substantial and that this prevention
would benefit affected long term care
facilities.
Decreasing Fire Recovery Disruption
and Time
In addition to losing less property due
to fire, we anticipate that long term care
facilities that experience fires would be
able to recover more quickly with fewer
rmajette on PROD1PC67 with PROPOSALS1
disturbances to residents. Because
sprinkler heads generally activate only
in the area immediately near the fire
source, the area that would be damaged
by a fire would likely be much smaller
in a sprinklered building than it would
VerDate Aug<31>2005 13:23 Oct 26, 2006 Jkt 211001
TABLE 1.—ESTIMATED ANNUAL FIRE DEATHS
Number of estimated annual fire-related
deaths if those facilities were sprinklered
be in a building without sprinklers, thus
reducing recovery costs. In addition, by
limiting the area affected by the fire,
there would be fewer disturbances to
residents during the recovery time.
While we cannot quantify these benefits
to long term care facilities and their
residents, we believe that they are
substantial and worth considering.
2. Costs
This proposed rule would require a
long term care facility to install an
approved, supervised automatic
sprinkler system in accordance with
NFPA 13, Standard for the Installation
of Sprinkler Systems, throughout the
building. This proposed rule would also
allow long term care facilities to install
automatic sprinkler systems within a
phase-in period to be determined based
on public comments. As described in
section IV.B.2 of this proposed rule, we
set forth the various contingencies,
assumptions, and data sources that we
used to develop our estimates. In
addition, in section IV.B.2, we present
our final estimates based on those
contingencies, assumptions, and data
sources.
Phase-In Period
We are soliciting public comment
regarding the length of a phase-in period
to allow long term care facilities to
install sprinklers. The cost of installing
sprinklers is substantial, and we do not
expect long term care facilities to have
$75,000 to $615,000, depending on the
size of the area requiring sprinklers and
the cost of installing sprinklers,
immediately available to purchase and
install sprinklers. We believe that a
phase-in period would mitigate the cost
of installing sprinklers by allowing
facilities time to reprioritize and
redistribute resources. At this time, we
do not know what would be the exact
length of the phase-in period.
For illustrative purposes only, we
have estimated the annual costs of this
proposed rule for 5-year, 7-year, and 10-
year phase-in periods. While we would
encourage all facilities to immediately
begin the process of purchasing and
installing sprinklers, we understand that
some facilities would choose to wait
until the very end of a phase-in period
to begin this process. Therefore, we
expect that the full cost of this proposed
PO 00000 Frm 00025 Fmt 4702 Sfmt 4702
Number of estimated annual lives saved by
sprinklers
5
rule would be distributed over a period
of several years as facilities nationwide
would likely stagger their installation
schedules to meet their individual
needs and circumstances.
Number and Size of Affected Facilities
We estimate that the installation
provision of this proposed regulation
would, over a 10-year phase-in period,
impact 1,947 partially sprinklered and
515 unsprinklered long term care
facilities. We based this estimate on
several elements.
The July 2004 GAO report on long
term care facility fire safety estimated
that 20 to 30 percent of long term care
facilities do not have sprinklers
throughout the facility and would
therefore be subject to the provisions of
this regulation.
We conducted a survey of all 18,005
long term care facilities. Facilities in 46
States and the District of Columbia
responded to the survey. Results from
the four States that did not respond
have been extrapolated based on the
pattern of responses from other States.
The survey found that 75.89 percent of
long term care facilities are fully
sprinklered. In addition, 15.2 percent of
long term care facilities were partially
sprinklered, and 4.14 percent did not
have any sprinklers. An additional 4.77
percent of facilities is unknown. The
4.77 percent of unknown facilities has
been distributed, based on the
previously cited percentages, into the
categories for fully, partially, and non-
sprinklered.
Of the 18,005 long term care facilities,
we estimate that 14,317 are fully
sprinklered. In addition, we estimate
that there are 2,867 partially sprinklered
facilities and 782 non-sprinklered
facilities (results of survey +
extrapolated results for non-responding
States + extrapolated unknown results).
Distributing numbers based on
percentages requires rounding, and can
result in facilities not being fully
accounted for. The above results do not
account for 39 facilities. For purposes of
our analysis, we assume that these 39
facilities are non-sprinklered, for a total
of 821 non-sprinklered facilities.
Therefore, we estimate that 14,317
facilities would not be impacted by this
proposed rule because they already have
sprinklers installed throughout their
E:\FR\FM\27OCP1.SGM 27OCP1
 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 62967

buildings. We estimate that 3,688
facilities could potentially be impacted
by this proposed rule because they do
not have sprinklers installed throughout
their buildings.
We estimate that, of those 3,688
facilities without sprinklers throughout,
435 partially sprinklered facilities, and
170 non-sprinklered facilities are
located either in States that have their
own long term care sprinkler
requirements (3) or in States that would
adopt the 2006 edition of the NFPA 101,
Life Safety Code (LSC) (12).
The NFPA included a requirement
that all existing long term care facilities
install sprinklers throughout their
buildings in the 2006 edition of the LSC.
The NFPA already requires that
sprinkler systems that are installed in
all buildings be maintained according to
NFPA 25.
Although Federal regulations require
the 2000 edition of the LSC, 12 States
have independently updated their
requirements to adopt the 2003 edition
of the LSC. We assume that these States
would continue to adopt the most recent
version of the LSC.
The 2006 edition has already been
released to the public, ahead of any final
CMS rule requiring sprinklers in all long
term care facilities. In adopting the 2006
edition of the LSC, those States would
require the long term care facilities
within their jurisdictions to install and
maintain sprinklers absent this
proposed rule. Therefore, facilities in
those States would not be impacted by
this proposed rule.
In addition, we assume that 2 percent
of existing long term care facilities
would be replaced or fully renovated
each year as part of the natural cycle of
facilities upgrading their
accommodations. Therefore, of the
initial 2,867 partially sprinklered and
821 unsprinklered facilities, we assume
that 57 partially sprinklered and 16
unsprinklered facilities would be
replaced or fully renovated each year. If
there were to be a 10-year phase-in
period, then 570 partially sprinklered
and 160 unsprinklered buildings would
likely be replaced or fully renovated
before the phase-in period would
expire.
Of these 570 and 160 facilities, we
estimate that 15 percent are in the States
that have independent sprinkler
requirements or would adopt the 2006
edition of NFPA 101, and would
therefore require sprinklers absent
Federal rulemaking. These 85 and 24
facilities (15 percent of 570 and 160
facilities) are captured in the 435
partially sprinklered and 170
unsprinklered facilities already
excluded from our impact analysis, as
described above. That leaves an
estimated 485 existing partially
sprinklered and 136 unsprinklered
facilities that would be naturally
replaced by new facilities with
sprinklers or fully renovated within, for
example, a 10-year phase-in period (570
naturally replaced or renovated facilities
¥85 in States that would require
sprinklers absent Federal rulemaking =
485 facilities; 160 naturally replaced
facilities ¥ 24 in States that would
require sprinklers absent Federal
rulemaking = 136 facilities). Likewise, if
there were to be a 7-year phase-in
period, then 399 partially sprinklered
and 112 unsprinklered buildings would
likely be replaced or fully renovated
before the phase-in period would
expire. If there were to be a 5-year
phase-in period, then 285 partially
sprinklered and 80 unsprinklered
buildings would likely be replaced or
fully renovated before the phase-in
period would expire.
This brings the total number of
estimated affected partially sprinklered
facilities to 1,947 (original 2,867
existing partially sprinklered facilities
¥ 435 facilities in States that would
require sprinklers absent Federal
rulemaking ¥ 485 existing facilities that
would be replaced or renovated
naturally over a 10 year phase-in period
= 1,947 partially sprinklered facilities
that would be affected by this proposed
rule). The total number of estimated
affected unsprinklered facilities is 515
(original 821 existing unsprinklered
facilities ¥ 170 facilities in States that
would require sprinklers absent Federal
rulemaking ¥ 136 existing facilities that
would be replaced naturally over a 10-
year phase-in period = 515
unsprinklered facilities that would be
affected by this proposed rule).
The same methodology was used to
identify the number of affected
unsprinklered and partially sprinklered
long term care facilities over 7-year and
5-year phase-in periods. These
estimates, displayed in table 3, are not
the same as the estimates for a 10-year
phase-in period because fewer facilities
would be naturally replaced or
remodeled during a 7-year or 5-year
phase-in than during a 10-year phase-in.
Therefore, more facilities would be
affected by this proposed rule.
Based on discussions with the
American Health Care Association and
State survey agencies, an average size
unsprinklered long term care facility has
100 resident beds and is 50,000 square
feet (50,000/100 or 500 square feet per
bed). Much larger long term care
facilities have recently been
constructed. However, as newly
constructed facilities, they are already
required to have sprinklers installed
throughout their buildings. Using the
methodology described above, table 3,
based on data from our sprinkler survey
and our Certification and Survey
Provider Enhanced Reporting system,
shows the size and number of affected
unsprinklered facilities over three
different phase-in periods.

TABLE 3.—NUMBER OF UNSPRINKLERED FACILITIES AFFECTED

Less than 50 50–99 beds 100–199 beds 200 or more Total number
beds (less (24,501– (49,501– beds (99,501 of affected
than 24,500 49,500 sq. ft) 99,500 sq. ft) or more sq. ft) facilities
sq. ft)

10 year phase-in .................................................................. 102 220 168 25 515

7 year phase-in .................................................................... 110 238 181 27 556
5 year phase-in .................................................................... 116 249 190 28 583

An average partially sprinklered square feet. Table 4 shows the size and facilities over three different phase-in
rmajette on PROD1PC67 with PROPOSALS1

facility also has 100 beds and is 50,000 number of affected partially sprinklered periods.

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 62968 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
TABLE 4.—NUMBER OF PARTIALLY SPRINKLERED FACILITIES AFFECTED
10 year phase-in ..................................................................
7 year phase-in ....................................................................
5 year phase-in ....................................................................
These buildings, however, would not
require sprinklers to be installed in all
areas because the building is already
partially sprinklered. For purposes of
this impact analysis, we assume that a
partially sprinklered building is 25
percent sprinklered, leaving 75 percent
of the building to be sprinklered in
accordance with this proposed rule.
Buildings in this category may have
more or less sprinkler coverage than this
assumption.
For facilities with fewer than 50
resident beds, we estimate that
sprinklers would be installed for 18,375
square feet (75 percent of maximum
square footage in this size category). For
facilities with 50 to 99 resident beds, we
estimate that sprinklers would be
installed for 27,750 square feet (75
percent of average square footage in this
size category). For facilities with 100 to
199 resident beds, we estimate that
sprinklers would be installed for 55,875
square feet (75 percent of average square
footage in this size category). For
facilities with more than 199 resident
beds, we estimate that sprinklers would
be installed for 75,000 square feet (75
percent of minimum square footage in
this size category).
Installation Cost Per Square Foot
Purchasing and installing a sprinkler
system according to the requirements of
NFPA 13 encompasses a wide variety of
factors, including those briefly
described in section II of this proposed
rule. Within the requirements of NFPA
13, there are numerous variables that
can impact the purchase and
installation costs for a facility. Each
facility has different needs that must be
addressed when purchasing and
installing a sprinkler system, and this
cost estimate cannot address each
particular need or combination of needs.
Therefore, we are basing our cost
estimates not on the individual
requirements of NFPA 13 for an
individual facility, but on a bundled
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purchase and installation estimate for
an average facility, as described below.
Individual facilities may have costs
VerDate Aug<31>2005 13:23 Oct 26, 2006
Less than 50 50–99 beds
beds (less (24,501–
than 24,500 49,500 sq. ft)
sq. ft)
253 561
272 603
285 631
above or below those of this average
facility due to facility size and facility-
specific sprinkler system needs. Long
term care facilities that are based in
other health care facilities, such as
hospitals, would be required by this
proposed rule only to have sprinklers in
the long term care facility section of the
building. Therefore, we do not believe
that facility-based long term care
facilities would have different
installation costs than freestanding
facilities with similar resident bed and
square footage numbers.
We estimate that it would cost
between $4.10 and $6.15 per square foot
to purchase and install a sprinkler in an
existing facility, with an average cost of
$5.50 per square foot. According to the
Architects, Contractors, Engineers Guide
to Construction Costs, 2004 Edition by
Design and Construction Resources,
purchasing and installing sprinklers in
new long term care facilities costs $2.05
per square foot. This cost estimate
incorporates all contractor costs such as
labor, materials, and a 20 percent
overhead fee; 35 percent taxes and
insurance on labor, equipment, and
tools; and 5 percent sales tax.
Although we recognize that capital
and interest costs may increase the cost
of purchasing and installing automatic
sprinkler systems in long term care
facilities, these costs are not included in
our estimates. Due to the individual
circumstances of each facility, unknown
future interest rates, and various other
factors, we are unable to accurately
estimate the capital and interest costs of
installing sprinkler systems. Therefore,
we have chosen to exclude these costs
from our estimates while acknowledging
that they do exist and will play a role
to some degree in the decisions of long
term care facilities that would be
affected by this proposed rule.
Renovation costs are typically two to
three times higher than new
construction costs because installing the
sprinkler system must be completed in
a piecemeal fashion while the building
remains occupied. This increases the
length of the construction time and,
Jkt 211001 PO 00000 Frm 00027 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
100–199 beds 200 or more Total number
(49,501– beds (99,501 of affected
99,500 sq. ft) or more sq. ft) facilities
745 388 1,947
801 417 2,093
838 436 2,190
thus, increases its costs. In addition,
renovations to add sprinkler systems
often require upgrading or adding
related building components such as
water lines and fire pumps. The
upgrades and additions require more
capital investment and construction
time. Increased investment and
construction time also increases costs.
For purposes of this impact analysis,
we assume that renovating a typical
facility to add sprinklers would cost
approximately 2.5 times more than
purchasing and installing sprinklers in
new long term care facilities. We do not
have a specific source for this
assumption; therefore, we have also
included cost estimates for facilities that
would pay $4.10 per square foot (2
times the cost of installing sprinklers in
new construction) and $6.15 per square
foot (3 times the cost of installing
sprinklers in new construction).
Cost Estimates
The cost estimates for both
unsprinklered and partially sprinklered
facilities are presented in the following
tables. They are based on all of the
above-described estimates about the
number of facilities that would be
affected, the sizes of those facilities, and
the installation costs per square foot. We
note again that the number of facilities
that would be affected by this rule
changes based on the length of the
phase-in period because fewer facilities
would be naturally replaced or
remodeled during a 7-year or 5-year
phase-in than during a 10-year phase-in.
Therefore, as the phase-in time is
shortened, more facilities would be
affected by this rule, increasing the
estimated cost impact of this proposed
rule.
Based on the above-described
estimates and figures, we estimate that
an unsprinklered facility meeting the
following size specifications would
have the following costs to comply with
the installation requirements of this
proposed regulation. (See table 5)
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 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules 62969

TABLE 5.—TOTAL INSTALLATION COST PER UNSPRINKLERED FACILITY

$4.10 per $5.50 per $6.15 per
square foot square foot square foot

> 50 beds (24,500 square feet) ................................................................................................... $100,450 $134,750 $150,675

50–99 beds (37,000 square feet) ................................................................................................ 151,700 203,500 227,550
100–199 beds (74,500 square feet) ............................................................................................ 305,450 409,750 458,175
<199 beds (100,000 square feet) ................................................................................................ 410,000 550,000 615,000
Total cost for 515 facilities (10 year phase-in) ............................................................................ 105,185,500 141,102,500 157,778,250
Total cost for 556 facilities (7 year phase-in) .............................................................................. 113,510,550 152,270,250 170,265,825
Total cost for 583 facilities (5 year phase-in) .............................................................................. 118,941,000 159,555,000 178,411,500

We estimate that a partially following size specifications would the installation requirements of this
sprinklered facility meeting the have the following costs to comply with proposed regulation. (See table 6)

TABLE 6.—TOTAL INSTALLATION COST PER PARTIALLY SPRINKLERED FACILITY

$4.10 per $5.50 per $6.15 per
square foot square foot square foot

> 50 beds (18,375 square feet) ................................................................................................... $75,338 $101,063 $113,006

50–99 beds (27,750 square feet) ................................................................................................ 113,775 152,625 170,663
100–199 beds (55,875 square feet) ............................................................................................ 229,088 307,313 343,631
More than 199 beds (75,000 square feet) .................................................................................. 307,500 412,500 416,250
Total cost for 1,947 facilities (10 year phase-in) ......................................................................... 372,868,849 500,189,749 541,842,556
Total cost for 2,093 facilities (7 year phase-in) ........................................................................... 400,825,249 537,692,224 582,472,102
Total cost for 2,190 facilities (5 year phase-in) ........................................................................... 419,309,099 562,487,624 609,342,841

Based on the different installation combined installation cost for all sprinklered) would range from
costs and phase-in lengths presented in impacted long term care facilities $478,054,349 to $787,754,341. (See table
this section, we estimate that the (unsprinklered and partially 7)

TABLE 7.—TOTAL INSTALLATION COST FOR ALL FACILITIES

$4.10 per $5.50 per $6.15 per
square foot square foot square foot

Total cost for 2,462 facilities (10 year phase-in) ......................................................................... $478,054,349 $641,292,249 $699,890,806
Total cost for 2,649 facilities (7 year phase-in) ........................................................................... 514,339,799 689,962,474 752,787,927
Total cost for 2,773 facilities (5 year phase-in) ........................................................................... 538,250,099 722,042,624 787,754,341

As stated earlier, we do not expect phase-in periods. While we would schedules to meet their individual
long term care facilities to have funds encourage all facilities to immediately needs and circumstances.
immediately available to purchase and begin the process of purchasing and The following tables show the
install sprinklers. Therefore, we propose installing sprinklers, we understand that estimated annual installation costs for
to allow a phase-in period of some facilities would choose to wait the phase-in periods based on the
undetermined length to help mitigate until the very end of a phase-in period estimated total cost figures shown in
the cost of installing sprinklers by to begin this process. Therefore, we
allowing facilities time to reprioritize table 7. The annual installation cost
expect that the full cost of this proposed estimates have been discounted at 3 and
and redistribute resources. rule would be distributed over a period
For illustrative purposes only, we 7 percent in order to compare the cost
of several years as facilities nationwide in today’s dollars to the cost in future
have estimated the annual costs of this
would likely stagger their installation dollars.
proposed rule for 10, 7, and 5-year

TABLE 8.—ANNUAL COSTS OVER ALL PHASE-IN PERIODS

[In millions]

$4.10 per $5.50 per $6.15 per

square foot square foot square foot

10 year phase-in .......................................................................................................................... 47.81 64.1 69.96

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7 year phase-in ............................................................................................................................ 73.48 98.6 107.53

5 year phase-in ............................................................................................................................ 107.65 144.4 157.55

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 62970 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
Maintenance
After installing an approved,
supervised automatic sprinkler system
in accordance with the 1999 edition of
NFPA 13 throughout the building, all
long term care facilities would be
required to test, inspect, and maintain
their sprinkler systems in accordance
with the 1998 edition NFPA 25. We
estimate that long term care facilities
would conduct quarterly inspections of
their sprinkler systems and annual trip
tests. We assume that each inspection
will take 4 hours to complete, at a cost
of $150 per inspection. We also assume
that each trip test would take 6 hours,
at a cost of $250. Based on these
assumptions, we estimate that long term
care facilities would spend $850
annually to test and inspect their
sprinkler systems. In addition, we
assume that long term care facilities will
spend an additional $150 annually to
perform any necessary maintenance
duties.
Individuals who perform these
testing, inspection, and maintenance
duties would have to be properly
trained and, in some States and local
jurisdictions, they would have to be
licensed. Generally, long term care
facilities would not have enough
sprinkler system work needs to directly
employ someone with the necessary
skills, training, and licensure. Therefore,
we believe that long term care facilities
would likely contract with another
company to meet their testing,
inspection, and maintenance needs. In
addition to actually conducting the
necessary testing, inspection, and
maintenance activities, we believe that
the contract would also include a
provision that the contractor prepares
adequate documentation of the activities
conducted. We estimate that the total
cost of meeting these requirements
would be $1,000 ($150 × 4 quarterly
inspections = $600 + $250 annual trip
test + $150 general maintenance costs =
$1,000).
In addition, all long term care
facilities that would be affected by this
proposed regulation would be required
to maintain documentation of all
inspection, maintenance, and testing
activities. The burden associated with
these requirements is estimated to be 1
hour per long term care facility.
Therefore, we estimate it would take
2,462 total annual hours (1 hour × 2,462
estimated affected long term care
rmajette on PROD1PC67 with PROPOSALS1
facilities) to meet this requirement. This
documentation maintenance
requirement would cost an affected
facility $19 a year, based on an hourly
rate of $19 for an office employee ($19
per hour × 1 hour). The total annual cost
VerDate Aug<31>2005 13:23 Oct 26, 2006 Jkt 211001
of this proposed documentation
requirement would be $46,778 ($19 per
facility × 2,462 facilities).
This estimated cost would be offset by
the elimination of the cost of
maintaining smoke alarms. Section
483.70(a)(7)(ii) requires long term care
facilities that did not have sprinklers
installed throughout their building to
have a program for testing, maintenance,
and battery replacement to ensure the
reliability of smoke alarms in their
facilities.
However, § 483.70(a)(7)(iii)(b)
exempts long term care facilities from
this smoke alarm maintenance
requirement if their facilities have
sprinkler systems throughout their
building that are installed, tested, and
maintained in accordance with NFPA
13. Therefore, long term care facilities
that install and maintain sprinkler
systems in accordance with this
proposed regulation would be exempt
from the existing requirement to
maintain their smoke alarms. Due to the
fact that all long term care facilities
would be exempt from this smoke alarm
requirement upon the phase-in date of
a final regulation, we plan to add a
sunset date to the smoke alarm
requirement upon finalization of this
sprinkler regulation. Based on the cost
estimates published in ‘‘Fire Safety
Requirements for Certain Health Care
Facilities; Amendment’’ (70 FR 15229,
March 25, 2005), we estimate that this
exemption would save an average long
term care facility that was affected by
the smoke alarm requirement $2,800
annually. This results in a net savings
of $1,800 annually ($2,800 savings from
not maintaining smoke alarms ¥$1,019
cost of maintaining sprinklers = $1,781
net savings).
C. Alternatives Considered
1. Maintain Current Fire Safety
Requirements
We currently require long term care
facilities to comply with the fire safety
requirements in the LSC. In addition,
we currently require long term care
facilities that do not have sprinklers
installed throughout the building to
have and maintain at least battery
operated smoke alarms in resident
rooms and public areas. We believe that
these requirements are a solid
foundation for ensuring that all long
term care facility residents are protected
from the threat of fire.
We also believe that these current
measures do not go far enough to protect
long term care facility residents. Both
the Hartford and Nashville facilities
were in substantial compliance with the
LSC, yet both facilities experienced
PO 00000 Frm 00029 Fmt 4702 Sfmt 4702 E:\FR\FM\27OCP1.SGM
severe fires with large numbers of
fatalities.
The smoke alarm requirement that we
published in the Federal Register on
March 25, 2005 (70 FR 15229) after
these fires was a step toward improving
fire safety and avoiding another
devastating fire. Unfortunately, smoke
alarms can only warn facility staff and
residents of the fire. They cannot
suppress a fire or prevent it from
spreading to other areas.
Long term care facility residents often
have multiple or severe health problems
that complicate the facility’s ability to
ensure their safety in the event of a fire.
For example, frail elderly residents may
rely on facility staff to assist them in
transferring and otherwise moving about
the facility. These types of residents are
unable to independently protect
themselves from the threat of fire by
moving away from the danger. They are
dependent on facility staff, who are also
responsible for ensuring the safety of
dozens of other residents. A rapidly
growing fire can overwhelm both the
staff and residents, leading to tragic
consequences.
However, a properly designed,
installed, and maintained sprinkler
system effectively prevents a fire from
spreading to other areas and
overwhelming the staff and residents.
Containing a fire reduces the threat to
residents in other portions of the
building and allows facility staff to
focus their energy on the area that is
most affected by the fire, without worry
about the fire spreading to other areas
and threatening other residents.
Sprinkler systems have consistently
served this function for many years, and
they are commonly recognized as the
single most effective fire safety device
currently available.
Given the past success of sprinkler
systems and their potential for saving
lives in the future, we believe that
maintaining the existing fire safety
requirements without adding sprinkler
requirements does not ensure the safety
of long term care facility residents to the
greatest extent possible.
In addition, maintaining the existing
fire safety requirements would have left
decisions regarding more stringent fire
safety measures in the hands of State
and local governments. State and local
governments have, in the past, made
very different decisions about fire safety
requirements in long-term care facilities.
For example, some States, such as
Tennessee and Virginia, already require
all long-term care facilities to have
sprinklers throughout their buildings. In
contrast, other States, such as Arkansas
and Nebraska, do not have such
requirements, resulting in 25 percent or
27OCP1
 Federal Register / Vol. 71, No. 208 / Friday, October 27, 2006 / Proposed Rules
more of their long-term care facilities
completely lacking sprinklers. This
level of variability is not acceptable
because residents of long-term care
facilities should be assured the same
minimum level of fire safety regardless
of what State or locality they reside in.
Federal regulation is the most efficient
and expedient manner for achieving the
goal of uniform nationwide minimum
fire safety standards; therefore, we chose
to pursue Federal regulation rather than
depending on State and local
governments.
2. Exempt Small Facilities
The Medicare Conditions of
Participation are the minimum
requirements that providers are required
to meet in order to be Medicare and
Medicaid certified. Many other
standards setting organizations have
requirements that go beyond what
Medicare and Medicaid require.
Facilities may choose to strive for these
higher standards, although Medicare
and Medicaid do not require them to do
so.
Exempting any facility from this
proposed minimum requirement would
be a disservice to the residents of that
facility. Residents deserve to be safe
from the threat of fire, whether they
reside in a large facility or a smaller one.
The proposed sprinkler requirement
would ensure that, regardless of the size
or location of their residence, all
residents are protected by the same
basic minimum fire safety requirements.
We believe that a phase-in period
would help to mitigate the costs of
installing sprinklers for small facilities
while ensuring that all residents are
protected by the same minimum
requirements. Therefore, we are not
proposing to exempt small facilities
from this requirement.
3. Require Immediate Compliance
Requiring immediate compliance with
the proposed condition would, we
believe, be a hardship for affected long
term care facilities. Designing a
sprinkler system, purchasing it,
installing it, and testing it all require a
significant amount of time. The typical
60-day delay in the effective date of a
regulation would not be sufficient time
to complete the entire sprinkler process.
For this reason, we have chosen not to
require immediate compliance. Instead,
we believe that it is appropriate to
rmajette on PROD1PC67 with PROPOSALS1
propose a several-year phase-in period
for this regulation.
We are specifically requesting public
comments and suggestions regarding the
length of a phase-in period in section
II.B of this proposed rule.
VerDate Aug<31>2005 13:23 Oct 26, 2006 Jkt 211001
D. Conclusion
For these reasons, we are not
preparing analyses for the RFA because
we have determined that this rule
would not have a significant economic
impact on small entities because the
estimated cost of the proposed
regulation would account for less than
1 percent of an affected facility’s
revenue over, for example, a 7-year or
10-year period.
In accordance with the provisions of
Executive Order 12866, this regulation
was reviewed by the Office of
Management and Budget.
List of Subjects in 42 CFR Part 483
Grant programs—health, Health
facilities, Health professions, Health
records, Medicaid, Medicare, Nursing
homes, Nutrition, Reporting and
recordkeeping requirements, Safety.
For the reasons set forth in the
preamble, the Centers for Medicare and
Medicaid Services proposes to amend
42 CFR chapter IV as set forth below:
PART 483—REQUIREMENTS FOR
STATES AND LONG-TERM CARE
FACILITIES
1. The authority citation for part 483
continues to read as follows:
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
Subpart B—Requirements for Long-
Term Care Facilities
2. In § 483.70, add new paragraph
(a)(7)(iv) and new paragraph (a)(8) to
read as follows:
§ 483.70 Physical environment.
(a) * * *
(7) * * *
(iv) The terms of paragraph (a)(7) of
this section shall remain effective
through the date specified at paragraph
(a)(8)(i) of this section.
(8) A long term care facility must:
(i) Install an approved, supervised
automatic sprinkler system in
accordance with the 1999 edition of
NFPA 13, Standard for the Installation
of Sprinkler Systems, as incorporated by
reference, throughout the building by
phase-in date to be determined. The
Director of the Office of the Federal
Register has approved the NFPA 13
1999 edition of the Life Safety Code,
issued July 22, 1999 for incorporation
by reference in accordance with 5 U.S.C.
552(a) and 1 CFR part 51. A copy of the
Code is available for inspection at the
CMS Information Resource Center, 7500
Security Boulevard, Baltimore, MD or at
the National Archives and Records
PO 00000 Frm 00030 Fmt 4702 Sfmt 4702
62971
Administration (NARA). For
information on the availability of this
material at NARA, call 202–741–6030,
or go to: http://www.archives.gov/
federal_register/
code_of_federal_regulations/
ibr_locations.html. Copies may be
obtained from the National Fire
Protection Association, 1 Batterymarch
Park, Quincy, MA 02269.
(ii) Test, inspect, and maintain an
approved, supervised automatic
sprinkler system in accordance with the
1998 edition of NFPA 25, Standard for
the Inspection, Testing and
Maintenance of Water-Based Fire
Protection Systems, as incorporated by
reference. The Director of the Office of
the Federal Register has approved the
NFPA 25 1998 edition of the Life Safety
Code, issued January 16, 1998 for
incorporation by reference in
accordance with 5 U.S.C. 552(a) and 1
CFR part 51. A copy of the Code is
available for inspection at the CMS
Information Resource Center, 7500
Security Boulevard, Baltimore, MD or at
the National Archives and Records
Administration (NARA). For
information on the availability of this
material at NARA, call 202–741–6030,
or go to: http://www.archives.gov/
federal_register/
code_of_federal_regulations/
ibr_locations.html. Copies may be
obtained from the National Fire
Protection Association, 1 Batterymarch
Park, Quincy, MA 02269.
(Catalog of Federal Domestic Assistance
Program No. 93.778, Medical Assistance
Program)
(Catalog of Federal Domestic Assistance
Program No. 93.773, Medicare—Hospital
Insurance; and Program No. 93.774,
Medicare—Supplementary Medical
Insurance Program)
Dated: September 23, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare &
Medicaid Services.
Approved: July 3, 2006.
Michael O. Leavitt,
Secretary.
[FR Doc. E6–17911 Filed 10–26–06; 8:45 am]
BILLING CODE 4120–01–P
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